If an insured person has received medical treatment in the same month from a single medical institution providing services covered by health insurance, pharmacy providing services covered by health insurance, or hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (ii) of the Act (hereinafter collectively referred to as a "medical institution providing services covered by health insurance, etc." in this paragraph and paragraph (5)), or from a designated home-nursing provider, and the co-payment payable pursuant to the provisions of the Act, the amount borne for medical expenses combined with treatment outside insurance coverage (meaning, where Article 85, paragraph (5) or (7) of the Act as applied mutatis mutandis pursuant to Article 86, paragraph (4) of the Act applies to the payment of medical expenses combined with treatment outside insurance coverage, the amount obtained by deducting the amount of those medical expenses combined with treatment outside insurance coverage from the amount of expenses calculated for the medical treatment relating to the payment of those medical expenses combined with treatment outside insurance coverage; the same applies hereinafter in this paragraph and paragraph (5)) or the amount borne for medical expenses for home-nursing (meaning, where Article 88, paragraph (6) of the Act applies to the payment of medical expenses for home-nursing, the amount obtained by deducting the amount of those medical expenses for home-nursing from the amount of expenses calculated for the designated home nursing relating to the payment of those medical expenses for home-nursing; the same applies hereinafter in this paragraph and paragraph (5)) has not been paid, the insurer is to pay, with respect to high-cost medical expenses under Article 41, paragraph (1) and paragraphs (3) through (5), to that medical institution providing services covered by health insurance, etc. or designated home-nursing provider, up to the amount obtained by deducting, from the amount of that co-payment, the amount borne for medical expenses combined with treatment outside insurance coverage or the amount borne for medical expenses for home-nursing, the amount specified in each of the following items in accordance with the category of cases listed in those items.
被保険者が同一の月に一の保険医療機関若しくは保険薬局若しくは法第六十三条第三項第二号に掲げる病院若しくは診療所若しくは薬局（以下この項及び第五項において「保険医療機関等」と総称する。）又は指定訪問看護事業者から療養を受けた場合において、法の規定により支払うべき一部負担金、保険外併用療養費負担額（保険外併用療養費の支給につき法第八十六条第四項において準用する法第八十五条第五項又は第七項の規定の適用がある場合における当該保険外併用療養費の支給に係る療養につき算定した費用の額から当該保険外併用療養費の額を控除した額をいう。以下この項及び第五項において同じ。）又は訪問看護療養費負担額（訪問看護療養費の支給につき法第八十八条第六項の規定の適用がある場合における当該訪問看護療養費の支給に係る指定訪問看護につき算定した費用の額から当該訪問看護療養費の額を控除した額をいう。以下この項及び第五項において同じ。）の支払が行われなかったときは、保険者は、第四十一条第一項及び第三項から第五項までの規定による高額療養費について、当該一部負担金の額、保険外併用療養費負担額又は訪問看護療養費負担額から次の各号に掲げる場合の区分に応じ、当該各号に定める額を控除した額の限度において、当該保険医療機関等又は指定訪問看護事業者に支払うものとする。